Duplex Ultrasonography Alone Is Sufficient for Mid-Term EVAR Surveillance: A Prospective Cost-Analysis Study
Beeman BR, Doctor L, Dougherty MJ, Doerr K, McAfee-Bennett S, Calligaro KD. Duplex ultrasonography alone is sufficient for mid-term EVAR
surveillance: a prospective cost-analysis study. Abstract presented at the 37th Annual Symposium of the Society for Clinical Vascular Surgery;
March 18-21, 2009; Ft. Lauderdale, Florida
OBJECTIVES:
After initially performing both serial CT scans and DU in our early experience with EVARs, we performed a prospective study using DU as the sole
surveillance study and determined cost savings and outcome using this strategy.
METHODS:
From September 21, 1998 to June 2, 2008, 276 patients underwent EVAR at a single institution. Until June 30, 2004, both CT and DU were
performed every six months during the first year and then annually if no problems were identified (Group 1). Aneurysm sac size, presence of
endoleak, and graft patency were compared between the two scanning modalities. After July 1, 2004, we prospectively used DU as the sole
surveillance study unless a problem was detected (Group 2). CT and DU costs were compared using 2008 Medicare Procedure codes
74160/72193 ($813) and 93979 ($232), respectively. All DU examinations were performed in our accredited non-invasive vascular laboratory.
Statistical analysis utilized Pearson's correlation coefficient and the paired t-test.
RESULTS:
Average follow-up was 24 months (range, 12-120). DU and CT scans were equivalent in detecting endoleaks (p < 0.0001), graft patency
(p < 0.0001) and determining aneurysm sac diameter (p < 0.0001). Using DU alone would have reduced the cost of EVAR surveillance by 70%
($282,924) in Group 1. Cost savings of $334,956 were realized in Group 2 by eliminating CT scan surveillance. No Group 2 patients suffered
an adverse event as a result of having DU performed as the sole follow-up modality.
CONCLUSIONS:
During mid-term follow-up, surveillance of EVAR patients can be performed both accurately and cost effectively with DU as the sole imaging study.
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